Multiples

Plagiocephaly

Anyone have success with battling the insurance companies (UHC) in getting them to cover cranial bands (helmets) due to multiples? I have read that you have a higher risk and more likely to get plagiocephaly with multiples due to space issues in utero. 

We have been concerned about the babies flat heads since they were a few weeks old. The pediatrician hoped it would round out as they spent more time on their stomachs, but after their 4 month checkup referred us to a plastic surgeon for a plagiocephaly evaluation. The plastic surgeon who uses star bands said it is not covered and its $3000 per child plus copays for office visits. I wasn't thrilled with the place, so looked into a few others.  DOC bands (also not covered) for $4000 a child and hanger cranial (not covered) but much more affordable at $1500 per child.  The hanger cranial place said they would also help us fight the insurance company. 

Does anyone have success with Hanger?  

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Re: Plagiocephaly

  • Sorry, no info about hanger but just wanted to share that my insurance did cover helmets for both my guys.....but we had $3000 deductibles anyway so we ended up paying regardless. I can't imagine they won't cover it if medically necessary?? My pediatrician had to provide a note that physical therapy did not work and helmets were recommended. We used starbandkids and our facility told us that's what insurance needed to approve it and it seemed to work. Good luck and feel free to pm me with any questions! 
    Fraternal twin boys born at 33 weeks 4 days Baby Birthday Ticker Ticker
  • I have UHC and my oldest twin's DOC band was covered. Read through your master plan of benefits carefully and be prepared to fight if its covered but your kid is denied. It was a six week battle to get it fully covered despite our master plan of benefits stating that it was. We are very happy with the results of the DOC band.
    Lilypie Premature Baby tickers
    Married 9/22/07, began TTC 8/10
    Diagnosed with DOR, LP defect, mild endometriosis and cysts
    BFP #1 EDD 9/10/11, natural miscarriage at 6w
    BFP #2 Medicated cycle, twin boys born 4/4/12 at 29w4d
    BFP #3 EDD 8/8/14, D&C for missed miscarriage at 8w, baby boy with triploidy
    BFP #4 June 2014 CP
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  • The plan says DME is covered, but orthotics to alter a body part aren't covered. They consider the problem "cosmetic".  

    I was hoping to fight the insurance company with a medically necessary diagnosis, but I think it's essential to start treatment now to get better results so we'll be forced to go with the more affordable option (hanger).  

    photo image-3.jpg Lilypie First Birthday tickers
  • imagejennifire7:
    The plan says DME is covered, but orthotics to alter a body part aren't covered. They consider the problem "cosmetic". nbsp;I was hoping to fight the insurance company with a medically necessary diagnosis, but I think it's essential to start treatment now to get better results so we'll be forced to go with the more affordable option hanger. nbsp;
    Take a close look to make sure there is no clause stating anything prior to age 18 is not considered cosmetic. We had the same DME clause but burried deep in there was the other clause that negated if for kids.
    Lilypie Premature Baby tickers
    Married 9/22/07, began TTC 8/10
    Diagnosed with DOR, LP defect, mild endometriosis and cysts
    BFP #1 EDD 9/10/11, natural miscarriage at 6w
    BFP #2 Medicated cycle, twin boys born 4/4/12 at 29w4d
    BFP #3 EDD 8/8/14, D&C for missed miscarriage at 8w, baby boy with triploidy
    BFP #4 June 2014 CP
  • imageMissa_g:
    imagejennifire7:
    The plan says DME is covered, but orthotics to alter a body part aren't covered. They consider the problem "cosmetic". nbsp;I was hoping to fight the insurance company with a medically necessary diagnosis, but I think it's essential to start treatment now to get better results so we'll be forced to go with the more affordable option hanger. nbsp;
    Take a close look to make sure there is no clause stating anything prior to age 18 is not considered cosmetic. We had the same DME clause but burried deep in there was the other clause that negated if for kids.

    We just started the process of fighting with insurance for the bands and it's looking pretty grim. We also have UHC. Both babies need it and it will be about $5000 (with the "twin discount"). Thanks for the tip about that clause. Any other tips to help fight it? 

    Lilypie Angel and Memorial tickers
    IVF #1 BFP b/g twins!; loss at 23 weeks due to I.C. and PTL. IVF #2 BFP 5/26/12; due date 2/6/13; TAC surgery 7/20/12, blessed with another girl & boy! 

    Lilypie Second Birthday tickers
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